Saved a woman last night. Then almost killed her. Typical for me--competence mitigated by callowness. I was doing a little soothing of some poor lady who had to endure several hours in the ED because her doctor was too lazy to admit her directly to the hospital. A nurse called "Dr.561" and there was something in the tenor of her voice that communicated that this was not "Dr.561, you have a phone call" but more likely "Dr.561 you have a (fill in the catastrophe)." Sphicter tightened, I jogged over. Medics had brought us some poor old lady gasping, struggling, gagging, frothing at the mouth, slapping her hands on the gurney, grasping at her chest. Her eyes bulged and rolled like a frightened horse's. "What's the story?" "Shortness of breath." And that's all the history we're going to get. Fortunately, at this point I know that regardless of what the disease is, the treatment is 23 cm of plastic. We move the lady to our bed, keep her upright, start breaking the intubation kit open, and try to get her on some oxygen. She drops out on us all of a sudden. From 60 breaths a minute to 2 in the span of a heartbeat. Her face starts to purple. I keep her upright (on the theory that....whatever) and then flop her down for the intubation. The resident is going to do it. What The Fuck?! Totally inappropriate! But I don't have enough confidence as an attending to tell him to back off so I let him give it a shot. He blows it, and I give him a second shot that he blows. Fuck this--I step in, crank that throat open and jam a 6.5 tube into her trachea. The problem was she had a narrow diameter, anterior lying airway with some edema around it. Also, she was awake and not paralyzed so her vocal chords were clapping open and shut adding another layer of difficulty. Good lord. What a sense of relief when I got that tube in place! Ahhhh.....a little breathing room. Time to think about the next step. And that's when things went wrong. Doing shit? I'm pretty good at the doing part of the job. But Thinking? Not soo much. I'm the anti-Hamlet of the ER. Because her BP was 263/100 and her heartrate was 160 and she was old I thought "Maybe this is an MI causing this sudden CHF, and we got to get that blood pressure down. Maybe just a touch, a whiff, of beta blockers....." And 10 of labetalol and forty seconds later her pressure was 1234/68! Perfect! And twenty seconds later her BP was 62/34--much, much, much less perfect. Shit, shit, shit, shit, shit. I put her on Levophed and feel really stupid. I go back to my hovel and dread her imminent death and having to explain this stupid decision of mine to her family, the ICU doc, and a jury of my peers. And at the point the Beautiful Biscuit shows up. Out of no where! It was so wondeful I had the odd sense I was hallucinating. She's miles from home, middle of the night, and she shows up at work with a burger and fries for me. It's 9:30 at night and I haven't eaten since 12 and if there's anything I was in the mood for more than some loving moral support it was a double cheeseburger. She was, as always, beautiful and happy and wonderful. She came by just to see me and bring me dinner. I wanted to go home with her right then. It was like water in a desert. She's phenomenal. Proposing to this girl is the best decision of my life. I don't know how I stumbled into a girl like this, but its miraculous. The woman pulled through, the Levophed came off, the ICU doc and cardiologist and I had a nice collegial discussion of it all. And I got out an hour late and went home to the wonderful Biscuit. It's a good, good life. U-561